Provider Demographics
NPI:1093309627
Name:NEWMAN, NICOLE MARY (OTD, MS, OTR/L)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARY
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:OTD, MS, OTR/L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARY
Other - Last Name:SALMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3910 SW BRUNSWICK ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7031
Mailing Address - Country:US
Mailing Address - Phone:860-681-5067
Mailing Address - Fax:
Practice Address - Street 1:1607 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9600
Practice Address - Country:US
Practice Address - Phone:772-291-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5578225X00000X
FLOT24388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist